Finding the "right medicine" with evidence-based treatment.
Personalized treatment methods applied with pharmacogenetic studies prevent trial-and-error methods. The genetic profile of individuals is determined and improvement is aimed with the right drug treatment. With this method, unnecessary and wrong medication is prevented. Stating that one of the ways of harming the patient is to leave the patient untreated, Prof. Dr. Nevzat Tarhan said, "Every medicine and treatment is personalized. If you know the gene map of the person, you will not give medication to the person by heart."
Üsküdar University Rector and psychiatrist Prof. Dr. Nevzat Tarhan emphasized the importance of personalized treatment methods.
Knowing the person's gene map prevents rote medication
Stating that people have to use unnecessary medication with the trial-and-error method applied in drug treatments, Prof. Dr. Tarhan said, "It is enough for a person to have his genetic profile once in his life. The genetic profile is for two purposes; one is the drug sensitivity panel. Is this drug sensitive to this person or not? The other one measures the way the person responds to the drug. If you know the gene map of the person, you will not give medication to the person by heart."
We prevent the person from taking unnecessary medication
Stating that personalized treatment facilitates the work of both the patient and the doctor, Tarhan said:
"This process can be done with blood or saliva taken from the mouth, but we cannot do all of the DNA analysis in Turkey. We send some of them abroad and do it. Those who go abroad come back in two to three weeks. The ones done here come back in three to five days. We make a drug genetic profile of this person. The person can use it like an identity card. But this is not a very common method. This method makes it easier for both the physician and the patient. The drug is found and given to the patient without trial and error. If you shoot at a target in the dark, the chance of hitting it is low. This method makes it easier. We prevent the person from taking unnecessary medication. The physician's intuition is also at the forefront here. Every physician who uses this method can achieve effortless success. Each drug has an ion charge. The ion charge of each drug can be measured in nanometers with devices that measure it (TDM) specific to that drug. Thus, it is understood whether the person is taking the drug or not.
No other substance can replace it. This is why it is called personalized treatment. Every medicine and treatment is personalized. Therefore, treatment should be approached with a sense of responsibility. One of the ways of harming the patient is to leave the patient without treatment. This is a very important theory. They say 'the earth covers the doctor's mistakes'. There should not even be the possibility of making a mistake when treating a person. The doctor should care about the patient and give a personalized treatment. This has been the case in the US for centuries, but it has only recently been accepted in our country. Changing people's prejudices is more difficult than changing machines. It is the biggest mistake to say 'It will not get better' without applying a method. The possibilities in the world should be tried, even if it is 1%, one should not give up hope."
This method is needed in psychiatry
Prof. Dr. Nevzat Tarhan stated that evidence-based treatment means "the applications are done on purpose and to the right extent" and said, "Non-evidence-based treatment is done with a little trial and error method. Classical, "Let's give this, let's see how the body responds, if not, let's give this..." In other words, this trial-and-error method is a difficult method. Both the disease and the job are completely up to chance. Sometimes treatment is delayed with this method. For this reason, especially in modern medicine, we are constantly working to determine the right drug, the right treatment, the right dose, the right duration for a person. For this, there is a branch of science called "pharmacology". Medical pharmacology is the pharmacogenetics of drugs; for example, the rate of metabolism in the body. Where and how is it broken down in the body? How does it react in which organ in the body it acts on? There is also the metabolism and breakdown of the drug itself, and the other measures the effect of the drug on the body. There is a branch of science related to this. There are some methods and measurements developed by this branch of science. It is important to apply these in treatment. Let's say you give a drug to a diabetic patient and you see that the sugar in his/her blood drops, you say, 'It works', you give a blood pressure medication and if his/her blood pressure drops, you say, 'It worked', but there was no such scale in psychiatry. There was a need for this. Actually, 'evidence' means doing a pre-test here and then a post-test. How are brain functions before treatment? Psychiatric drugs mean drugs that already affect brain function. The target organ is the brain."
It is necessary to apply the 3T Rule
Stressing the importance of the 3T rule, Prof. Dr. Nevzat Tarhan said, "These are: Diagnosis, treatment and follow-up. If you do not make the diagnosis first, the treatment will remain in the air. If treatment is not enough, follow-up is necessary. It is necessary to apply the 3T rule. In order to do these, we need an indicator, a scale. From those scales, we need evidence about this brain function used in psychiatry. That is why we call it evidence-based treatment. Evidence has a pyramid. The evidence at the bottom is; doesn't this treatment, this medicine, this method work? First, the weakest evidence in the pyramid of evidence is case reports. 'I mean, I used this treatment on this person and it worked well, this is a case. Another expert said, 'I also used it and it worked well. This is the accumulation of cases," he said.
Giving the wrong medicine is like a chemical weapon
Underlining the need to follow a path with evidence-based treatments, Prof. Dr. Nevzat Tarhan said, "Hippocrates' famous saying 'First do no harm' describes this. It is necessary to take steps based on evidence, otherwise you will do unethical things and harm the patient. For example, in Antalya, a 15-year-old boy was given epilepsy medication. There is an indication for the physician, but if he had acted based on evidence, this incident would not have happened. In America, that drug is not given without genetic analysis. If you are prescribing that drug, is there a factor that will prevent the appropriate metabolism of that epilepsy drug to that person or not? For example, there is a gene related to the mitochondria of the DNA wall. If there is no gene that metabolizes that gene, that person is not given that drug. It will immediately cause sudden death in that person. You will test whether that gene is present or not after giving the drug. That should be the last resort for such risky drugs. The child went to the doctor. While there were many medicines, he gave him the last medicine. So prescribing here is applying chemical weapons to the person. But when you try to eliminate his disease, you damage another organ, so giving the wrong medicine is applying a chemical weapon to that person. Therefore, one should not use medicine on the advice of friends. We hear women recommending antidepressants to each other on a daily basis. These are chemical weapons. They are given according to the body's needs. You can fall into a coma just like that," he warned.
Every person has a different structure
Drawing attention to the differences in people's bodies, Prof. Dr. Nevzat Tarhan concluded his words as follows
"One of the first things medical students learn in medical schools is 'There is no disease, there is a patient'. In other words, every person has a different structure. Let's say there is a disease, but there are different variations in the physiology of the body. There are different variations in the anatomy of organs. Now let's say you are operating somewhere. Normally, with classical methods, you open the vein, you enter here, you find the organ, you operate, but if there is an anatomical variation, you open it and you find something different. But experience is important in such cases. Now, those drugs are metabolized by the proteins produced by our genes within the limits of the foods, drugs and what we eat. For example, a goat digests paper. No other living creature can digest paper. Just like this genetic trait, there are traits that vary from person to person. Like drug metabolism. In the metabolism of some people, the gene is metabolized slowly. Then the drug has a side effect. Some people have fast metabolizers. If you give an elephant dose of medicine, it has no effect. What do you do in such cases? Phenotyping is done by finding the appropriate drug for that person. TDM laboratory was the first to do this in Turkey. This system allows us to understand whether it is metabolized fast or slow in the body and develop a treatment method accordingly."